New Treatment Offers an Alternative to Amputation for Patients with Melanoma

Isolated limb infusion may prevent the need for radical surgery

December 2011

Patients diagnosed with metastatic melanoma on a limb have traditionally had limited options for fighting the often deadly form of skin cancer. Surgery is often impossible or would require large portions of tissue be removed - even the entire arm or leg. Northwestern Medicine oncologists are now offering an alternative approach that focuses on saving the limb while eliminating or shrinking the cancer, and may avoid the need for radical surgery altogether. The procedure, called isolated limb infusion, is performed at only a handful of medical centers across the country due to the complexity of the approach and expertise of the team required.

During the procedure, doctors use a tourniquet to temporarily stop blood flow to the limb. A high-dose of heated chemotherapy medication is then injected into a main artery of the affected limb using a catheter to target the cancer. By isolating the limb, doctors are able to prevent the otherwise toxic high-dose chemotherapy drugs from affecting other organs. Following the treatment, drugs are flushed out through the main vein with a second catheter and circulation to the limb is returned to normal.

"This is a remarkable and frequently effective option for treating patients who otherwise would face amputation or disfiguring surgery," said Karl Bilimoria, MD, surgical oncologist at Northwestern Memorial and member of the Lurie Cancer Center.

Melanoma can take over a patient's arm or leg without having spread to other places in the body. In those cases, this treatment allows the limb to be treated and preserved. According to Bilimoria, approximately two-thirds of patients will significantly benefit from the treatment, with noticeable shrinkage of the tumor in as little as one month.

"Isolated limb infusion is capable of providing long-term tumor control and better long-term survival," said Bilimoria, who is also an assistant professor of surgery at Northwestern University Feinberg School of Medicine. "We are pleased to be able to offer an alternative that can increase their chance of survival, preserve their limb, and improve their quality of life."

For patients like Larry Black, who was diagnosed with melanoma in the fall of 2010, hearing that an alternative treatment was available provided hope at a time when he felt like he was in a losing battle with cancer.

"Before coming to Chicago, I had undergone several treatments that failed to get rid of the cancer," said Black. "I was watching the spots on my arm grow and was worried nothing could be done to stop it from spreading. When I got a second opinion from Dr. Bilimoria and learned there may be a different treatment that could help, I had a renewed sense of hope and was ready to keep fighting."

Black was the first patient to be treated with isolated limb infusion at Northwestern Memorial.

"There has been a noticeable decrease in the number and size of the tumors on Larry's arm and he no longer requires pain medication," said Bilimoria.

Black is grateful he learned about this option and thankful that he did not have to turn to amputation. "I need this arm to hold my fishing rod," said Black.

The outpatient procedure takes approximately two hours to complete. Side effects are limited, but the limb must be monitored closely in the hospital for a few days following surgery.